Joanne Nicholson, Ph.D.

A Multi-disciplinary,

Whole-of-Family Approach

to Supporting Parents with

Mental Illness

October 2010

Joanne.Nicholson@Umassmed.edu

www.parentingwell.org

Disclosures

with Karen Albert, M.S., Kathleen Biebel,

Ph.D., Bernice Gershenson, M.P.H., Beth

R. Hinden, Ph.D., Valerie Williams, M.A.,

M.S., Brenda Warren, B.S., Chip Wilder,

LICSW, Toni Wolf, B.A. & Katherine

Woolsey, B.A.

We have received support from state, federal, and

foundation sources, and from AstraZeneca

for non pharmaceutical research.

Our Work is Informed by Research & Practice

• Survey & ethnographic studies of individuals & families over time

• National surveys & site visit projects

• Development & testing of our own interventions

• Consultation & training to numerous federal, state & local policy makers, providers, consumers & family members

Today’s Talking Points

• Family members are likely to have multiple and overlapping needs & roles – individuals with mental illness, carers & siblings.

• There are many opportunities & strategies for intervention.

• The best care requires the engagement of multiple stakeholders working in partnership.

“Trends and technologies may change, but from the Stone Age to

the Internet age, two aspects of life remain constant: Family can be the source of great joy and sorrow, and

parenthood is a challenge.”

(Sarah Rodman, Boston Globe, February 28, 2010, p. N1)

Parent Well-being& Function-

ing

Family,Stress &Supports

ChildCharacter-

istics

ChildWell-being &Functioning

Intervention

Intervention

Intervention

ManyOpportunities

for Intervention& Support

Mental

Illness

Substance

Abuse

Parents &

Children

Trauma

A Whole-of-Family Approach: Families are the focus of mental health promotion, mental illness prevention, treatment and rehabilitation

Families can take many forms. Children may be living with birth parents, step-parents,

relatives, foster families, adoptive families, or in other

“formal” or “informal” arrangements.

“…You know, some people think you shouldn’t have a baby because you

have mental illness and because you’re on medication.”

“…How to be a good role model for your kids when you have problems of

your own…you want your child to grow up to be a healthy, well-

adjusted adult…”

“You have to go to work. You gotta’ ‘come home. You gotta’ deal with the kids, deal with your own home. Your own problems, you know, really start

piling up.”

“…No medication is going to slow me down. I have a 2-1/2 year old

daughter. I have to be active for that reason. I have to be right behind her

everywhere she goes…”

“…In reality I don’t want to go [to the hospital]. I want to be home. I want

to be the mother. I want to be in charge of the house…cooking,

cleaning, taking care of everybody, changing diapers.”

“…When you’re doing good, nobody’s there for you…but when they find out

the least little bit wrong, they’re there on you, letting you know all the

negative... no positive.”

“And when they come in and they say, ‘We’re taking what you have left--that’s keeping you alive’…What do

you think then?…You’re a failure completely…”

“…trust issues too. How do I know this person will care for my baby?

What if they don’t take proper care?”

“…How do you establish a loving relationship with your child…when you’re not with them a lot? They

don’t see you on a regular basis and you can’t show them your love in the

normal ways…”

What must be put into place to support the optimal functioning & positive

relationships of adults who are parents & their children, family members &

carers—in times of stability & in anticipation of times of difficulty?

Working with Individuals in a Family Context/Working with Families

Key Ingredients for Success When Adults with Mental Illness

are Parents

• Family-centered

• Strengths-based

• Trauma-informed

Key Ingredient: Family-Centered

Integration of adult & child services

Interagency collaboration

Funding to meet unique needs identified by families

Key Ingredient: Strengths-Based

Non-judgmental approach

Support of positive role models

Key Ingredient: Trauma-Informed

Safe environment

Trustworthy, dependable relationships

Attend to issues of power & control

Family-centered, strengths-based, trauma-informed practices require

a paradigm shift in the way providers view and intervene with

individuals.

It takes a village…

• Multigenerational & developmental approach

• Multiple sectors working together

• Recovery in adults: achieving goals & reducing adverse outcomes

• Resilience in children: supporting strengths & addressing needs

What does it take to create the village?

Leveraging Partnerships to Coordinate & Create Services for Families

• Changing the way we do business

• Changing the business we do

Provide Family-informedTreatment & Services

• Consider family roles & context.

• Ask about reproductive issues & goals for family life.

• Anticipate impact of treatment recommendations on parent’s functioning.

Enhance Existing Strategies:provide family-informed…

Supported housing

Supported employment

Supported education

Peer support

Services for children & youth

Create Family-focusedIntervention Strategies

• The Family Project

• Parenting Options Project

• Family Legal Support Project

• Homeless Families Project

• Family Options

Family Options

• Recovery & resilience are family matters (family-centered, trauma-informed)

• Family goal planning based on strengths & needs assessment (strengths-based)

• Family Coaches, Program Director, Clinical Consultant, Parent Peers (psych rehab, parenting & life skills, family psychoeducation)

• Family team of professional, natural & peer support providers (wraparound)

Preliminary Conclusions:Family Options Outcomes

• Significant improvements in mothers’ functioning & well-being at 6 & 12 mos.

• Significant increase in supports & resources at 6 mos.

• Families achieved individualized goals.

• Families transitioned to less intensive contact at about 12 mos.

Family Options Implementation Challenges: Creating…

• The workforce capacity

• The organizational capacity

• The community capacity

The Workforce Capacity

• Identify skill sets for working with families• MH/Child welfare, adults and children, strengths-based,

family focused services

• Recruit staff with relevant experience• Balance characteristics with credentials

• Educate staff to intervention model• Literature, researchers/consultant experts in parental

mental illness, site visits

• Develop targeted trainings to address challenges• Psychosocial rehab specialists address goal planning with

families

The Organizational Capacity

• Develop tools & resources to identify family strengths & goals• Family strengths assessment form

• Family goal form

• Operationalize protocols & procedures• Maximize what exists, e.g., petty cash

• Develop what doesn’t exist, e.g., flex funds

• Facilitate communication pathways among ALL components of agency• Internal marketing

• Resource sharing, information exchange

The Community Capacity

• Locate sustainable resources for families• Logistics meetings re: families’ needs and strategies to

access services

• Nurture new relationships with community agencies• Informational events, kick-off, trainings

• Reinvigorate existing community relationships• Reintroductions, face-to-face meetings

• Leverage partnerships to coordinate services for families• Team meetings with providers to coordinate and

maximize services

Some Final Suggestions:

• Educate - colleagues in other disciplines & fields, e.g., primary care, education.

• Coordinate – help families navigate systems & access services.

• Collaborate – build bridges among services & supports; policy makers, providers & researchers.

• Partner – with families to achieve their goals.

“My children give me strength,they give me hope,

they give me the will to survive…”

Contact us: Joanne.Nicholson@Umassmed.edu